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Piggy-back or cava replacement - which implantation technique protects liver recipients from acute kidney injury and complications

Widmer, JD; Schlegel, A; Ghazaly, M; Davidson, BR; Imber, C; Sharma, D; Malago, M; (2018) Piggy-back or cava replacement - which implantation technique protects liver recipients from acute kidney injury and complications. Liver Transplantation 10.1002/lt.25334. (In press). Green open access

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Abstract

The cava-preserving piggyback technique requires only partial cava clamping during anhepatic phase in liver transplantation (LT) and therefore maintains venous return and may hemodynamically stabilize the recipient. Hence, it is an on-going debate, if piggy-back implantation is more protective from acute kidney injury (AKI) after LT when compared to classic cava replacement technique. The aim of this study was therefore to assess the rate of AKI and other complications after LT comparing both transplant techniques without the use of veno-venous bypass. We retrospectively analyzed the adult DBD liver transplant cohort between 2008 - 2016 at our center. Liver and Kidney function, and general outcome including complications were assessed. Overall 378 transplantations were analyzed, of which 177 (46.8%) were performed as piggy-back and 201 (53.2%) as cava replacement technique. AKI occurred equally often in both groups. Transient renal replacement therapy was required in 22.6% and 22.4% comparing piggy-back and cava replacement technique (p=.81). Further outcome parameters including complication rate were similar in both cohorts. Five-year graft and patient survival was comparable between the groups with 81% and 85%, respectively (p=.48; p=.58). In conclusion, both liver implantation techniques are equal in terms of kidney function and overall complications following liver transplantation.

Type: Article
Title: Piggy-back or cava replacement - which implantation technique protects liver recipients from acute kidney injury and complications
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1002/lt.25334
Publisher version: https://doi.org/10.1002/lt.25334
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: complications, implantation technique, kidney injury, liver transplantation
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci > Department of Surgical Biotechnology
URI: https://discovery.ucl.ac.uk/id/eprint/10057875
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